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Biomedical subjects

K Lützén

Publications and source records attributed to K Lützén.

At least 19 recordsLinked to original sources
PubMed2006

Living by themselves? Psychiatric nurses' views on supported housing for persons with severe and persistent mental illness.

The main principle directing the development of supported dwellings for persons with long-term mental illness is that to live in the community would improve their quality of life. The aim of this study was to describe psychiatric nurses' experiences of different types of supported dwelling for persons with long-term mental illness, and their views on what they consider to be important principles to provide for in order to facilitate their social integration into the community. Nine psychiatric nurses were interviewed. A qualitative content analysis revealed 'attempting to uphold the principle, respect for the patient's right to self-determination' as the main theme, which was linked to three sub-themes: the nurses' view on their moral responsibility; the nurses' views on social norms that patients must follow in order to be accepted by their neighbours; and the nurses' views on supported dwelling of good quality. The nurses perceived that personal contact between the neighbour and the mentally ill person was one essential way to reduce fear of the mentally ill person. They viewed themselves as a link between the mentally ill person and other neighbours. Without the personal contact between the mentally ill person and the neighbours, there may be a risk that the integration will fail no matter how excellent the supported dwelling is framed.

Adult↗
PubMed2002

Psychosocial disadvantages in the lives of persons with long-term mental illness living in a Swedish community.

The aim of this study was to gain in-depth knowledge of how persons with long-term mental illness experience their everyday situation, in order to identify potential psychosocial obstacles to a meaningful existence. The focus was on psychosocial aspects, such as contact with others and the quality of these contacts. An ethnographic design was used, in order to provide an inside perspective. Four persons with long-term mental illness participated in the study. Three open-ended interviews, at 1-week intervals, were conducted with each informant. Analysis of transcribed material consisted of naive reading and content analysis guided by the investigators' understanding of the psychiatric context. Three themes were generated: feeling lonely but being unable to establish friendships; knowledge of what to do but lacking initiative; and awareness of the need for support but not wanting to be subject to control. These themes reflect contradictions between thoughts, feelings and actions, which seem to contribute to a psychosocial disadvantage in the life of persons with long-term mental illness.

Humans↗
PubMed2001

The haemodialysis machine as a lifeline: experiences of suffering from end-stage renal disease.

AIM: The aim of this study was to describe patients' experiences of suffering from end-stage renal disease (ESRD). RATIONALE: The rationale was to investigate how persons find meaning or make sense of their situation and how they experience suffering. The theoretical basis for the study was to view suffering at three levels. The first level was related to sickness and treatment. The second level was related to the care provided and the third level was related to each person's unique life experience and existence. METHOD: Data were collected by interviews focusing on questions concerning daily life, needs, and expectations for the future. A qualitative interpretative content analysis was used. Fifteen patients between the ages of 50-86 participated in the study. FINDINGS: Two main themes were identified describing these patients suffering. The first theme, 'the haemodialysis machine as a lifeline' consisted of three subthemes: 'loss of freedom', 'dependence on the caregiver', and 'disrupted marital, family and social life'. The second theme 'alleviation of suffering' consisted of two subthemes: 'gaining a sense of existential optimism' and 'achieving a sense of personal autonomy'. CONCLUSION: This study indicated that, in the lives of patients on haemodialysis, the main areas of suffering were related to loss of freedom expressed as dependence on the haemodialysis machine as a lifeline and, the caregivers. This time-consuming and tiring dependence affected marital, family and social life. Alleviation of suffering could be achieved by accepting dependence on the haemodialysis machine and maintaining autonomy by being seen as an individual by the caregivers.

Activities of Daily Living↗
PubMed2001

Psychiatric nurses' attitudes towards patient autonomy in depot clinics.

AIM: The aim of this qualitative study was to explore how psychiatric nurses experience patient autonomy in relation to their professional role in depot clinics. BACKGROUND: The administration of depot neuroleptics at outpatient clinics is a common task for psychiatric nurses in many countries. The procedure is characterized by brief contacts often allowing little opportunity for adequate monitoring of the treatment and a dialog between nurses and patients. As nurses have an important role in involving patients in decision-making, there is a need to analyse the nurses' attitudes towards giving depot neuroleptics from the perspective of autonomy. METHOD: Nine experienced psychiatric nurses were interviewed using open-ended questions. The steps of a phenomenological descriptive method guided the data analysis. FINDINGS: The structure describes how benevolent attitudes towards patient autonomy motivated the nurses' interventions in relation to how they experienced their own professional authority. The structure consists of four variations: (1) Beneficent interventions used with patients perceived as co-operative when the nurses experienced a high degree of professional authority. (2) Paternalistic interventions used with patients perceived as ambiguous towards medication when the nurses experienced an arbitrary professional authority in collaboration with team members. (3) Weak paternalistic interventions used with patients perceived as unwilling when the nurses experienced having sufficient professional authority in the treatment situation. (4) Nonmaleficent interventions used with patients perceived as being resigned when the nurses experienced a low degree of professional authority within the team. CONCLUSIONS: The findings indicate that psychiatric nurses' experience of their professional authority is closely related to the organization of the depot treatment and that brief contacts do not favour the establishment of collaborative relationships with patients. When injection-giving nurses, as patients' key workers, have overall responsibility for co-ordinating the patients' treatment they can encourage patient autonomy by helping patients understand the meaning of depot medication and its benefits. Further clinical research regarding the involvement of nurses in the treatment as well as patients' experiences of treatment with depot neuroleptics is needed to allow suggestions about improvements of the organization of the treatment.

Adult↗
PubMed2001

Nurses' experiences of research utilization within the framework of an educational programme.

This paper explores nurses' reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme. Ten registered nurses, all in clinical practice, participated in a research-orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants' wards. Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research. Organizational and leadership issues, nurses' interest in research, nurses' reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important. This study confirms that research utilization and the change to research-based nursing practice are complex issues which require both organizational and educational efforts.

Attitude of Health Personnel↗
PubMed2001

Dissonant imperatives in nursing: a conceptualization of stress in intensive care in Sweden.

The aim of this study was to explore nurses' experiences of stress within the context of intensive care. The theoretical perspective for the study builds on a cognitive-phenomenological-transactional theory of stress and coping and the theory of cognitive dissonance. Respondents were 36 registered nurses recruited from 10 intensive care units (general, neonatal and thoracic units). Their experience as nurses ranged from one to 32 years. These intensive care units had similar structural characteristics, namely a high working pace, advanced technology, constrained finances, frequent reorganizations, a shortage of registered nurses and all were filled to overcapacity. Data were collected in open-ended interviews that were audio-taped and transcribed. A content analysis identified four contradictory themes: (1) controlled by the work situation--needing to be in control; (2) constrained by prioritization--wanting to do more; (3) lacking the authority to act--knowing that something should be done; and (4) professional distance--interpersonal involvement. These four themes were synthesized at a higher level of abstraction into a main theme: stress induced by dissonant imperatives, which conceptualizes nursing stress in the intensive care unit. In conclusion, dissonant imperatives might lead to stress in intensive care nursing.

Humans↗
PubMed2001

The first nurse-patient encounter in a psychiatric setting: discovering a moral commitment in nursing.

The aim of this study was to deepen nurses' understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient's suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson's caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty.

Ethics, Nursing↗
PubMed2000

Living a restricted life with Ehlers-Danlos syndrome (EDS).

Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder, primarily affecting the skin, ligaments, joints and blood vessels. The symptoms can vary from undiagnosed cases with mild symptoms to more severe forms. A qualitative study was conducted with the purpose of exploring how individuals with different symptoms of EDS describe their symptoms and perceive their daily life. Eleven interviewees were recruited via a support group in Sweden. The main strategies of the grounded theory method were used in collection and analysis of data. The identified main theme, "Living a restricted life", seemed to explain the way in which fears, pain, stigmatisation and experiences of non-affirmation in health-care limited the possibility of self-actualisation in daily living and social life. This study provides a conceptual framework for future research and an understanding of the type of professional support individuals with EDS require.

Adaptation, Psychological↗
PubMed2000

The first nurse-patient encounter in a psychiatric context: an initial study in an action research process.

This paper presents an initial study undertaken as the first step in action research concerning the first encounter between the nurse and the patient on psychiatric admission. The specific aim was to identify obstacles and possibilities of starting an ongoing learning process with mutual agreement upon goals and a good working relationship between the principal investigator and the participating nurses. Participant observation and questionnaires, completed by nurses and patients, were used in the data collection. The main finding was the identification of parallel processes concerning patients and nurses as to experiences of the abandonment and the lack of confirmation and autonomy. This initial study confirms the need and satisfies the requirements for continuing the action research process.

Hospitalization↗
PubMed2000

Transforming the exhausting to energizing process of being a good parent in the face of cancer.

The aim in this study was to gain a deeper understanding of the interaction between women who have been treated for breast cancer and their children. The focus was on how they deal with being a mother at the same time attending to their own needs. The main strategies of the grounded theory method were used to conceptualize the interactive process involved. Nine women, with children aged 4 to 23, living at home at the time of diagnosis, were interviewed. By the process of constant comparative analysis, the main theme that seemed to capture how the lives of these women had changed was transforming the exhausting-to-energizing process in being a good parent in the face of cancer. This theme is related to Meleis's concept of health-illness transition. The findings here indicate the need for family counseling, with special attention paid to the single parent with cancer.

Adult↗
PubMed2000

The morality of treating patients with depot neuroleptics: the experience of community psychiatric nurses.

The aim of this qualitative study was to gain an understanding of the meaning that community psychiatric nurses impart to their everyday interactions with patients in depot neuroleptic treatment situations. Nine experienced community psychiatric nurses were interviewed using semistructured, open-ended questions. Data analysis was by the phenomenological descriptive method according to Giorgi. Four themes were identified, highlighting aspects of the moral meaning of treating patients with depot neuroleptics: (1) 'benevolent justification' occurs when nurses perceive that the patient's welfare is at stake; (2) 'inability to advocate the patients' best interest' occurs when nurses feel they are at a disadvantage; (3) 'accommodative interactions' occur when nurses are able to respond to a patient's expressed needs; and (4) 'acceptable advocacy' occurs when physicians are sensitive to nurses' suggestions on patients' treatment. The findings indicate that treatment care planning involving both patients and nurses is essential to enhance patients' autonomy, which is a precondition for satisfactory interactions. This phenomenological study describes the meaning that nurses give to administering depot neuroleptic injections to patients in the context of community psychiatric clinics. The phenomenon of concern was identified as the moral aspect in the interactions with individual patients in the treatment situation.

Adult↗
PubMed2000

Moral sensitivity: some differences between nurses and physicians.

We report the results of an investigation of nurses' and physicians' sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories 'meaning' and 'autonomy' and to a lesser degree with the categories 'benevolence' and 'conflict'. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females.

Ethics, Medical↗
PubMed1999

Intrusion into patient privacy: a moral concern in the home care of persons with chronic mental illness.

The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A constant comparative analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of 'home'. This reflected the health care workers' conflict between their professional role and their moral role, which they perceived as unclear.

Chronic Disease↗
PubMed1998

Subtle coercion in psychiatric practice.

Making nursing decision for patients who cannot communicate their own wishes and needs is a common problem in psychiatric and mental health nursing. The aim of this article is to present the findings of a qualitative study focused on situations in which patients do not cooperate with a nursing decision about what should be done for them. The design of the study utilized some steps associated with the grounded theory method. Data were collected from unstructured interviews with 10 British nurses with long experience in psychiatric nursing. By implementing the strategy of constant comparative analysis of the transcribed interviews, it was found that nurses use different types of subtle coercion in order to achieve their own goals for the patient. These goals were justified as being in the best interest of the patient. The main components of subtle coercion are part of a process consisting of: assessing a patient's competency for self-choice; acting strategically; modifying the principle af autonomy; justifying strategies; and reflecting ethically on the action taken. The study indicates that further empirical investigation of clinical situations involving subtle coercion is required. Particular attention should be paid to organizational factors and how these contribute to the use of subtle coercion. A specific question that needs to be theoretically and empirically explored is, can coercion be justified as 'ethically right' in some situations but not in others?

Choice Behavior↗
PubMed1997

Living with dizziness: an explorative study.

A qualitative study was conducted for the purpose of exploring how patients with dizziness manage their daily living. Ten patients with history of dizziness were recruited from the out-patient clinic, Department of Audiology, in a hospital in Stockholm. Collection and analysis of data were inspired by the method of grounded theory. Four themes were developed that described the experience of living with dizziness: vulnerable reactions, affirmation and non-affirmation, finding ways to carry on daily living, and expressing the need for health care support. These themes seem to conceptualize these patients' difficulties and needs in relationship to living with dizziness and, given the small sample, have implications for nursing practice and provide a framework for a broader study.

Activities of Daily Living↗
PubMed1997

Nursing ethics into the next millennium: a context-sensitive approach for nursing ethics.

The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care.

Cultural Diversity↗
PubMed1997

Moral sensitivity in psychiatric practice.

This study reports the results of a study of Swedish psychiatrists' responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice.

Adult↗